Abstract
Since tanned skin may be perceived as a marker of beauty in American pageant culture, we evaluated pageant contestants regarding motivations for tanning, skin care behaviors, and possible tanning addiction. Responses were analyzed via summary statistics and compared across Fitzpatrick skin types. Statistically significant differences were found between skin types regarding tanning frequency, feelings of attractiveness after tanning, and perceptions of elevated mood after tanning. Contestants also demonstrated limited skin care behaviors; nearly 70% of respondents examined their skin for moles less than monthly. Of all respondents, 34% met tanning-modified Cut–Annoyed–Guilty–Eye-opener (CAGE) criteria, suggesting possible tanning addiction. This study raises several considerations regarding the possible addictive nature of tanning and the importance of skin safety in the pageant population.
Keywords: Pageants, skin, survey, tan, tanning addiction
Tanned skin may be perceived as a marker of beauty in American pageant culture. Major pageant systems such as Miss USA and Miss America have endorsed official tanning sponsors; however, no studies have explored contestants’ attitudes toward tanned skin and skin health. We aimed to evaluate pageant contestants regarding motivations for tanning, skin care behaviors, and possible tanning addiction using the Cut-Annoyed-Guilty–Eye-opener (CAGE) criteria. 1–4
METHODS
Women who had competed in at least one pageant were recruited via Facebook pageant groups and regional network contacts to complete a 20-question, institutional review board–approved questionnaire. Data collection stopped when a target of 50 surveys were completed. The survey included both multiple-choice and open-ended questions. Analysis included summary statistics and a single P value derived from chi-square testing for questions in which participants were able to select a single response for each available category and responses were divided by Fitzpatrick skin type.
RESULTS
Table 1 compares responses by Fitzpatrick skin type, which spans from type I (pale white skin; always burns, never tans) to type VI (dark brown or black skin; never burns, always tans). As shown in the table, there were statistically significant differences between contestants of different skin types regarding tanning frequency, feelings of attractiveness after tanning, and perceptions of elevated mood after tanning. Contestants with skin types II and III (fair skin to darker white skin) reported the highest levels of tanning frequency, with >50% tanning at least several times per year. Conversely, all contestants with type I (pale white skin) and type VI (dark brown or black skin) reported tanning once a year or less. Most respondents with types I through V (pale white skin to brown skin) reported feeling more attractive when tanned, but no respondents with type VI (dark brown or black) felt more attractive when tanned.
Table 1.
Survey responses of pageant contestants based on Fitzpatrick skin phototype
|
Fitzpatrick skin phototype
a
|
||||||||
|---|---|---|---|---|---|---|---|---|
| Type I(n = 6) | Type II(n = 12) | Type III(n = 13) | Type IV(n = 13) | Type V(n = 4) | Type VI(n = 2) | Total(n = 50) | P value | |
| Initial exposure to tanning | 0.26 | |||||||
| Previous pageant queens | 3 (50%) | 5 (42%) | 8 (62%) | 1 (8%) | 2 (50%) | – | 19 (38%) | |
| Social media | 1 (17%) | 3 (25%) | – | 3 (23%) | 1 (25%) | – | 8 (16%) | |
| Tanning sponsors | – | – | 1 (8%) | – | – | – | 1 (2%) | |
| Pageant coaches | – | 3 (25%) | 1 (8%) | 3 (23%) | 1 (25%) | – | 8 (16%) | |
| Do not associate tanning with pageants | 1 (17%) | – | 3 (23%) | 4 (31%) | – | 2 (100%) | 10 (20%) | |
| Other b | 1 (17%) | 1 (8%) | – | 2 (15%) | – | – | 4 (8%) | |
| Frequency of indoor or outdoor tanning | 0.02 | |||||||
| Never | 6 (100%) | 1 (8%) | 1 (8%) | 4 (31%) | – | 1 (50%) | 13 (20%) | |
| Rarely (once a year or less) | – | 2 (17%) | 3 (23%) | 2 (15%) | 2 (50%) | 1 (50%) | 10 (20%) | |
| Occasional (few times/year) | – | 7 (58%) | 7 (54%) | 6 (46%) | 1 (25%) | – | 21 (42%) | |
| Monthly | – | – | – | – | 1 (25%) | – | 1 (2%) | |
| Weekly | – | 1 (8%) | 1 (8%) | 1 (8%) | – | – | 3 (6%) | |
| Several times a week | – | 1 (8%) | 1 (8%) | – | – | – | 2 (4%) | |
| Possible tanning addiction (CAGE questionnaire modified for tanning) | 2 (33%) | 3 (25%) | 7 (54%) | 3 (23%) | 2 (50%) | 0 (0%) | 17 (34%) | 0.43 |
| Consideration of tanned skin as a valued characteristic in pageantry | 5 (83%) | 11 (92%) | 11 (85%) | 12 (92%) | 4 (100%) | 1 (50%) | 44 (88%) | 0.56 |
| Feeling of being more attractive when competing with tanned skin | 4 (67%) | 10 (83%) | 13 (100%) | 11 (85%) | 3 (75%) | 0 (0%) | 41 (82%) | 0.02 |
| Perception that tanning seems to elevate mood | 1 (17%) | 5 (42%) | 12 (92%) | 9 (69%) | 2 (50%) | 0 (0%) | 29 (58%) | 0.01 |
| Frequency of checking skin for moles | 0.29 | |||||||
| Never | 1 (17%) | – | – | 2 (15%) | 1 (25%) | – | 4 (8%) | |
| Rarely (once a year or less) | – | 3 (25%) | 5 (38%) | 4 (31%) | – | 2 (100%) | 14 (28%) | |
| Occasional (few times/year) | 4 (67%) | 4 (33%) | 3 (23%) | 4 (31%) | 1 (25%) | – | 16 (32%) | |
| Monthly | – | 4 (33%) | 3 (23%) | – | 1 (25%) | – | 8 (16%) | |
| More than monthly | 1 (17%) | 1 (8%) | 2 (15%) | 3 (23%) | 1 (25%) | – | 8 (16%) | |
| Frequency of wearing sunscreen | 0.09 | |||||||
| Never | – | – | 1 (8%) | – | – | 1 (50%) | 2 (4%) | |
| Rarely (<50% of the time) | – | 4 (33%) | 3 (23%) | 4 (31%) | 3 (75%) | – | 14 (28%) | |
| Sometimes (50% of the time) | 1 (17%) | 3 (25%) | 6 (46%) | 2 (15%) | – | – | 12 (24%) | |
| Often (>50% of the time) | 2 (33%) | 3 (25%) | 1 (8%) | 3 (23%) | 1 (25%) | – | 10 (2%) | |
| Always | 3 (50%) | 2 (17%) | 2 (15%) | 4 (31%) | – | 1 (50%) | 12 (24%) | |
Fitzpatrick skin phototypes: type I has pale white skin (always burns, does not tan), type II has fair skin (burns easily, tans poorly), type III has darker white skin (tans after initial burn), type IV has light brown skin (burns minimally, tans easily), type V has brown skin (rarely burns, tans darkly), and type VI has dark brown or black skin (never burns, always tans).
Open-ended responses to other initial exposures to tanning include “just a thing you do to compete,” “just wanted to be tan and not washed out,” and prior exposure to tanning during other activities such as dance.
While 92% of respondents with type III (darker white) skin perceived an elevation in mood after tanning, no respondents with type VI (dark brown or black skin) perceived a change in mood. Of all respondents, 34% met CAGE criteria for tanning addiction, with two or more “yes” responses to the following questions: Have you ever felt you should cut down on tanning? Have people annoyed you by criticizing your tanning? Have you ever felt bad or guilty about tanning? Have you ever felt the need to tan first thing in the morning?
Pageant contestants reported that their initial exposure to tanning in pageantry included interactions with previous beauty queens (38%), social media (16%), and pageant coaches (16%). Despite the popularity in tanning, contestants demonstrated limited skin care safety behaviors. Nearly 70% of respondents examined their skin for moles less than monthly. Only 24% reported always wearing sunscreen, and 32% wore sunscreen less than half the time. The highest fraction of sunscreen usage was in type I skin type (pale white skin), with 100% usage of sunscreen at least half of the time.
Figure 1 summarizes open-ended responses from respondents about their perception of tanning in pageantry. Common responses included the need to tan in order to prevent “looking washed out” on stage and the popular concept of “if you can’t tone it, tan it!”—referring to the perceived use of tanning to improve physical physique for competition.
Figure 1.
Respondent perception of tanning in pageantry: Open-ended responses.
DISCUSSION
This survey raises several considerations. First, many respondents were exposed to tanning by previous contestants, social media, and pageant coaches. Therefore, recruitment of positive role models in the pageant industry to speak about sun safety and photo-protective behaviors may reduce tanning frequency and improve skin care behaviors. Second, most respondents reported an elevation in their mood after tanning, and more than one-third of respondents met modified CAGE criteria for tanning addiction. This presents important insight on the possible addictive nature of tanning and the difficulties of reducing tanning frequency. Lastly, it is important to promote routine skin checks and continual sunscreen usage in this population at risk for high ultraviolet light exposure.
Limitations include inability to assess demographic or clinical differences between respondents and non-respondents, limited sample size, and limited generalizability, as most participants were recruited from a localized Texas region.
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